While we use the term "MCO" in this report to refer to entities who manage MLTSS services under contract to the state, technically the plans in Michigan, North Carolina and Pennsylvania are Pre-paid Inpatient Health Plans (PIHPs).

Galantowicz S. Environmental Scan of Measures for Medicaid Title XIX Home and Community Based Services: Final Report. AHRQ Publication No. 10-0042-EF. Agency for Healthcare Research and Quality, Rockville, MD. June 2010. http://www.ahrq.gov/research/ltc/hcbsreport. Accessed June 26, 2013.

Government Accountability Office. Medicaid Home and Community-Based Waivers: CMS Should Encourage States to Conduct Mortality Reviews for Individuals with Developmental Disabilities. GAO-08-529 May 23, 2008.

National Home and Community-Based Quality Enterprise. NQE Quality Brief: Mortality Investigation and Review in Medicaid Home and Community-Based Services Program. April 27, 2012.

In those instances where a state appears not to have implemented all the essential quality elements delineated in CMS' guidance document, we remind the reader that our data collection occurred prior to, and approximately contiguous with, the release of CMS' directive in May 2013. As such, this study's description of state practices (or their absence) to assess compliance with federal expectations should be avoided.

CAHPS is actually a family of measure sets, focusing on consumers' experience with different aspects of the health care delivery. Separate CAHPS instruments have been developed and tested for assessing consumer experience of health plans, hospitals, dental services, Medicaid, home health, nursing home, prescription drug plan, clinician and group, behavioral health, patient-centered medical home, and Medicare Advantage plans.

The state legislature mandated that as of October 1, 2013, the number of PIHPs will be reduced to ten new regional entities for simplification and equity statewide and to prepare mental health and developmental disability systems for increased integrated care approaches.

The PIHPs must also be a designated Community Mental Health Services Program.

The QIC is a stakeholder group comprised of consumers, advocates, provider organizations, PIHPs and Community Mental Health Service Programs.

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